神经外科昏迷患者锁骨下静脉插管（CVC）导管血栓及纤维鞘形成的护理研究

目的：探究神经外科昏迷患者锁骨下静脉插管（CVC）导管血栓及纤维鞘形成的护理的应用价值,以指导临床工作.方法：选取 2014年 4 月-2015年 5月我院的 72 例神经外科昏迷患者为研究对象,并将研究对象随机分为观察组和对照组两组,每组36例,对照组仅给予常规护理干预,观察组在对照组干预护理的基础上采用针对血检及纤维鞘形成的干预护理,即采用低分子肝素封管,尿激酶溶栓,配合其他的护理,对比分析两组患者血检及纤维鞘的首次形成率、再形成率以及并发症情况.结果：观察组首次血栓和纤维鞘形成率41.67%;再次血栓和纤维鞘形成率27.78%,均显著低于对照组的75.00%、61.11%,差异均有统计学意义（P 〈 0.05）;观察组感染 1 例, 出血3 例 , 导管皮下隧道扭转1例,导管打折1例,并发症发生率为16.67%;对照组感染5例,出血4例,导管皮下隧道扭转4例,导管打折3例,并发症发生率为44.44%;两组并发症发生率比较,差异有统计学意义（P 〈0.05）.结论：导管血栓及纤维鞘形成的干预护理,能降低管血栓及纤维鞘的形成率,减少并发症的发生,值得广泛应推广应用于临床.

objective： to explore the neurosurgery coma patients with subclavian vein intubation catheter thrombosis （CVC） and the application of the fibrous sheath formation of nursing value and to guide clinical work. Methods： April 2014 to May 2015 of our hospital, 72 cases of neurosurgery coma patients as the research object, and the research subjects were randomly divided into observation group and control group in the two groups, 36 cases in each group, control group given routine nursing intervention, only observation group in the control group on the basis of nursing intervention on blood tests and fiber sheath formation of nursing intervention, namely using low molecular heparin sealing tube, urokinase thrombolysis, cooperate with other care, compared two groups of patients with blood tests and fiber sheath formation rate and formation rate and complications for the first time. Results： the observation group of thrombosis and fiber sheath formation rate was 41.67% for the first time; Again, thrombosis and fiber sheath formation rate was 27.78%, were significantly lower than the control group were 75.00%, 61.11%, the difference had statistical significance （P 〈 0.05）; Observation group infection in 1 case, bleeding in 3 cases, catheter subcutaneous tunnel reverse in 1 case, discounted catheter in 1 case, the incidence of complications was 16.67%; Control infection in 5 cases, hemorrhage 4 cases, catheter subcutaneous tunnel turn 4 cases, catheter discount 3 cases, the incidence of complications was 44.44%; The complication rate of two groups of comparison, the difference was statistically significant （P 〈 0.05）. Conclusion： nursing intervention and fiber sheath catheter thrombosis formation, can decrease the rate of tube the formation of thrombus and fiber sheath, reduce complications and is worth popularizing widely should be applied in clinical.